Beam hardening artifacts of liquid embolic agents: comparison between Squid and Onyx

Pop, Raoul; Mertz, Luc; Ilyes, Annamaria; Mihoc, Dan; Richter, Johann Sebastian; Manisor, Monica; Kremer, Stéphane; Beaujeux, R.

doi:10.1136/neurintsurg-2018-014542

Cited by 32 publications

(38 citation statements)

References 16 publications

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“…This feature may be the result of the smaller amount of tantalum inside SQUID compared to Onyx (30% less than Onyx). 8 In our cases, SQUID 12 demonstrated faster penetration toward the fistula, ease of plug formation and no entrapment of the microcatheter. We achieved cDAVF cure on immediate post-treatment angiography in 17 out of 19 patients with a complete occlusion rate of 89%.…”

Section: Discussionsupporting

confidence: 48%

“…11 Compared to Onyx, it seems to have a restrained reflux and fewer artifacts on CT. 12 SQUID is an EVOH copolymer that has become recently available in 4 different formulations, of which the most innovative is SQUID 12 because of its lower viscosity. 8 Currently, PHIL 25% LV is the only commercially available version of nonadhesive LEAs comparable to SQUID 12. 13 About this, Vollherbst et al reported not significantly differences between these 2 embolic agents in an in vivo endovascular embolization model, in particular in terms of embolization extent and the amount of reflux.…”

Section: Discussionmentioning

confidence: 99%

“…While SQUID 18 has similar characteristics to other LEAs, SQUID 12 is innovative because of its lower viscosity. 8 We review our preliminary experience in endovascular treatment of cDAVFs with SQUID 12 with the aim of evaluating its safety, effectiveness, and midterm follow-up results.…”

Section: Introductionmentioning

confidence: 99%

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Endovascular treatment of cerebral dural arteriovenous fistulas with SQUID 12

et al. 2020

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Background Endovascular therapy with liquid embolic agents (LEAs) is the gold standard for the treatment of cerebral dural arteriovenous fistulas (cDAVFs). The aim of the study is to retrospectively evaluate effectiveness, safety, and midterm follow-up results of endovascular treatment of cDAVFs using SQUID 12. Methods Between June 2017 and January 2020 the authors retrospectively reviewed clinical, demographic and embolization data of 19 consecutive patients with cDAVF who underwent embolization using SQUID 12. The number of arteries catheterized for each procedure, the total amount of embolic agent, the occlusion rate, the injection time, any technical and/or clinical complications were recorded. Mid-term follow-up with DSA was reviewed. Results 20 procedures were performed in 19 patients. A transarterial approach was accomplished in 19 procedure; a combined transvenous-transarterial approach was realized in 1 treatment. The average time of injection was 33 minutes (2–82 minutes), and the average amount of SQUID 12 was 2.8 mL (0.5–6 mL). Complete angiographic cure at the end of the procedure was achieved in 17 patients. No major periprocedural adverse events were recorded. Mid-term follow-up was achieved in 15 out of 19 patients and confirmed complete occlusion of the cDAVFs in 13/15 patients (87%); in 2 of the initially cured patients a small relapse was detected. Conclusions The treatment of the cDAVFs using SQUID 12 was effective and safe. The lower viscosity seems to allow an easier penetration of the agent with a high rate of complete occlusion of the cDAVFs.

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Section: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

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Endovascular treatment of cerebral dural arteriovenous fistulas with SQUID 12

et al. 2020

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“…Squid-18, such as in case of Onyx use, is suggested for initial plug formation, while the new formulation Squid-12 can improve vascular penetration and spread more distally. Another advantage of Squid over Onyx is related to the reduced percentage (30%) of tantalum which can improve vessels visualization during embolization and limit metallic artifacts at imaging follow-up (Gioppo et al, 2017), as also recently demonstrated (Pop et al, 2018). Squid was always administered using DMSO-compatible coaxial microcatheters as straight Renegade Hi-flo (Boston) or curved Carnelian (Tokai): the peculiar cobra-shaped tip of Carnelian was useful in selected cases of marked tortuosity of the target artery, as for example in VAA (splenic) or type 2 endoleak embolization.…”

Section: Discussionmentioning

confidence: 79%

Transcatheter embolization with Squid, combined with other embolic agents or alone, in different abdominal diseases: a single-center experience in 30 patients

et al. 2019

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Background: Squid, as Onyx, is an ethylene-vinyl alcohol copolymer (EVOH)-based liquid embolic agent developed for neuroradiologic interventions with poor application in abdominal district. Our aim was to evaluate safety, complications, and efficacy of transcatheter embolization using the two available formulations Squid-18 and 12, in 30 patients affected by different abdominal diseases. Results: Transcatheter embolization with Squid, combined with other embolic agents, as poly vinyl alcohol (PVA) particles, coils and amplatzer plugs, or alone (type 2 endoleak), was performed in 30 patients, as follows: 10 portal vein embolizations (PVEs), 6 arteriovenous malformations (AVMs), 5 visceral artery aneurysms (VAAs), 4 type 2 endoleaks, 3 preoperative embolizations, 1 acute arterial bleeding, 1 female varicocele. Squid was always administered using dimethyl sulfoxide (DMSO) compatible microcatheters. Technical success, 30-day clinical success and complications were assessed. Technical success was 90%. 3 patients (2 AVMs, 1 VAA) required re-intervention successfully performed in all cases. Major complications, cases of microcatheter entrapment and DMSO-related poor pain control were not recorded. 30-day clinical success was 93.3%: in 2 patients submitted to PVE a sufficient future liver remnant (FLR) hypertrophy was not achieved. Conclusion:Squid was successfully used with low complication rate in many abdominal diseases showing a valid embolic action either combined with other embolic agents or alone in type 2 endoleak. The availability of different formulations (Squid-18 and Squid-12) variable for viscosity makes Squid preferable to Onyx as EVOH-based liquid embolic agent, even though comparable studies in different abdominal districts with a larger cohort of patients will be necessary.

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“…They are similar but Squid, marketed more recently, is also available in the less viscous formulation which spreads more distally and may be useful in selected cases, as for example to treat arteriovenous malformations [8,14]. Another advantage of Squid over Onyx is the reduced percentage (less 30%) and smaller size of tantalum particles conditioning fewer metallic artefacts on CT images [15,16]. Compared to adhesive liquid embolic agents as glue, Squid and Onyx are more expensive but can provide a more predictable formulation-dependent distribution, resulting in more homogeneous casts.…”

Section: Discussionmentioning

confidence: 99%

Emergency tips recanalisation and gastroesophageal varices embolisation with an ethylene vinyl alcohol copolymer agent (Squid) and detachable coils

et al. 2020

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Transjugular intrahepatic portosystemic shunt (TIPS) is currently indicated as first therapeutic option in the main complications of portal hypertension, including bleeding gastroesophageal varices and refractory ascites. In case of bleeding gastroesophageal varices, an adjuvant embolisation within TIPS can be useful to prevent rebleeding. In the present technical note, the management in emergency of a patient with haemorrhagic shock due to bleeding gastroesophageal varices and occluded TIPS is reported. TIPS recanalisation with an adjunctive stent and high-pressure balloon angioplasty and gastroesophageal varices embolisation using detachable coils and a non-adhesive liquid embolic agent were performed during the same emergent procedure. After the procedure, clinical stabilisation of the patient was achieved, with blood transfusions suspension and Blakemore tube removal. At 6 months, regular TIPS patency at colour Doppler and no rebleeding episodes were recorded. To our knowledge, whilst coils are routinely used for varices embolisation, non-adhesive liquid embolic agents have been never mentioned. Liquid embolic agents seem to provide a stable plug strengthening the embolising action of the coils. Further studies involving a cohort of patients with long-term follow-up will be necessary to confirm whether this association can be more effective than coils alone in gastroesophageal varices embolisation.

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Beam hardening artifacts of liquid embolic agents: comparison between Squid and Onyx

Cited by 32 publications

References 16 publications

Endovascular treatment of cerebral dural arteriovenous fistulas with SQUID 12

Endovascular treatment of cerebral dural arteriovenous fistulas with SQUID 12

Transcatheter embolization with Squid, combined with other embolic agents or alone, in different abdominal diseases: a single-center experience in 30 patients

Emergency tips recanalisation and gastroesophageal varices embolisation with an ethylene vinyl alcohol copolymer agent (Squid) and detachable coils

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